This study developed an anxiety management application for healthcare providers in managing and reducing their anxiety through various strategies and protocols integrated into the application. Effective strategies for controlling and reducing anxiety informed the design of the application. The literature review revealed limited studies on anxiety-reducing applications specifically for healthcare staff. Most studies focused on stress or treated anxiety as a secondary focus. This research is the first to design a comprehensive anxiety management application for healthcare personnel, incorporating key strategies from comparable studies. Cognitivebehavioral therapy (CBT) was commonly identified as effective, but ACT has recently gained attention for its long-term benefits; only five articles directly addressed anxiety [13, 15, 33,34,35], while the others treated anxiety as a secondary focus or concentrated primarily on stress [36,37,38,39,40]. Each of these studies employed limited methodologies in their applications. Therefore, this research represents the first effort to design a comprehensive anxiety management application specifically for healthcare personnel, drawing on findings from systematic reviews and qualitative studies. The proposed application incorporates key strategies identified in comparable studies.
The quantitative and qualitative analyses of the demographic information of the interviewees were not conducted. However, based on their interviews, it can be inferred that job position directly correlated with the level of anxiety experienced. According to the results from other studies, individuals working in emergency and ICU departments tend to experience higher levels of anxiety due to the critical nature of these areas [41, 42]. Additionally, it has been observed that women experience higher levels of anxiety compared to men, a finding that is clearly evident in most studies [43, 44]. According to the results of other studies, age and work experience do not have a significant impact on the level of anxiety, and these two factors do not have a specific correlation with anxiety levels [45]. However, individuals in the early stages of their careers tend to experience higher levels of anxiety. Over the long term, the relationship between work experience and anxiety becomes negligible [46].
In the current research, we incorporated Acceptance and Commitment Therapy (ACT) for assessing anxiety levels, alongside the Cohen Perceived Stress Scale (PSS), which is related to ACT. The Beck Anxiety Inventory (BAI), which focuses on somatic symptoms, was also used. Furthermore, since self-efficacy and mindfulness are factors associated with anxiety, regular measurements of knowledge, quality of life, and self-efficacy can yield more comprehensive results. Thus, we employed the General Self-Efficacy Scale (GSE-17) and the Five Facet Mindfulness Questionnaire (FFMQ). In previous studies [15, 34, 35, 38, 39], anxiety levels were measured using scales such as STAT, GAD, PSS, and PASS.
These questionnaires were utilized in similar studies [14, 33]. According to the reviews conducted, cognitive-behavioral therapy was identified as an effective and applicable protocols for reducing anxiety among healthcare provider [13, 15, 37, 38]. This protocol is recognized as a viable therapeutic approach for alleviating anxiety, and the results of other studies have reported positive outcomes associated with this treatment method [47, 48]. Notably, none of the reviewed studies mentioned acceptance and commitment-based protocols as a therapeutic intervention for reducing anxiety. However, this method has recently gained attention from psychotherapists and demonstrated better long-term effect [49,50,51] This application utilizes this protocol for the first time. The findings indicate that ACT helps individuals identify their values and take consistent actions, leading to reduced anxiety and tension. Hayes et al. (2006) sustained this finding, highlighting that ACT may substantially enhance anxiety and mental health by emphasizing accepting thoughts and emotions, maintaining present moments awareness without judgment, and adhering to fundamental life values [52]. Fledderus et al. (2012) reported that the beneficial effects of ACT led to improved mental health. This study focused on “Acceptance and Commitment Therapy as a structured self-help intervention for psychological distress and enhanced mental health” [53]. The results from the qualitative section also indicated that individuals had not previously engaged in their treatment using this method, and they had temporarily reduced their anxiety through the cognitive-behavioral therapy protocol employed by psychologists.
Meditation, mindfulness, and yoga are additional strategies for reducing anxiety. These techniques were included in only three studies [14, 33, 34] as effective modules for anxiety reduction in mobile applications. In the current research, these methods were also employed as reduction strategies, with each section incorporating multiple relaxation sessions and exercises. Furthermore, the effectiveness of these strategies in alleviating anxiety among healthcare providers has been demonstrated in other studies [54, 55]. Mindfulness, which is a fundamental aspect of ACT, reduces anxiety through daily practice. This finding is consistent with the research conducted by Vøllestad et al., which identified mindfulness and ACT as significant and effective approaches for anxiety reduction [56] and that in ACT, individuals are taught to concentrate on the present moment utilizing techniques such as meditation and yoga. This method assists individuals in releasing concerns related to the past or future, enhancing their focus on present experiences [57]. The analysis of the qualitative section revealed that these exercises were very effective in reducing anxiety; however, due to time constraints, the participants did not have the opportunity to attend training classes. Following these exercises through an application was deemed an effective and beneficial approach Breathing exercises, specifically diaphragmatic breathing, are another anxiety control strategy that was utilized in one study [40] as a reduction technique within the mobile application. This method helps users relax by focusing on their inhalation and exhalation. Additionally, results from other studies indicated that breathing exercises significantly contribute to the management and reduction of anxiety [58, 59]. Therapeutic breathing exercises were identified as valuable suggestions in the qualitative section. Because the interviewees were in a clinical setting, they recognized the positive aspects of this exercise and expressed enthusiasm for practicing it.
One effective way to reduce anxiety is training for preparedness in stressful situations. In this study, one of the health program modules provided training to healthcare providers, which helped reduce their anxiety through self-management [33]. Ebrahimi et al. [60] conducted an interventional study to examine the impact of educational interventions on the anxiety of nurses working in hospitals affiliated with Arak University of Medical Sciences. Their results indicated that teaching skills and techniques for mental relaxation, along with conducting continuous exercises, significantly alleviated hospital staff anxiety. In the current study, a section was dedicated to training for preparedness in emergencies and disasters. This section includes protocols for educational preparedness in emergencies and disasters, designed for all healthcare providers across various occupational categories, facilitated by disaster health specialists. Given that the interviewees were familiar with the educational protocols, they recommended that these protocols be included as a reminders section.
The results of another study indicated that nature exploration interventions through virtual reality effectively reduce anxiety and stress [35]. Supporting this finding, other studies have highlighted the positive impact of nature on alleviating anxiety [61]. Consequently, one of the modules in the present study was dedicated to facilitating nature tours, allowing users to learn about nature tour opportunities in their city and take action to register for them. The results of the qualitative section indicated that most individuals sought recreation, particularly nature excursions, to reduce their anxiety and made an effort to spend time in nature during holidays. They also responded positively to the nature exploration section of the application, which they consider one of the best ways to alleviate anxiety.
In mobile-based applications designed for managing and controlling diseases, there is typically a section titled “My Medications,” which enables users to manage their medications in terms of dosage and timing of consumption. The reminder feature of the medication system helps individuals with busy schedules or forgetfulness take their medications on time, thereby enhancing the effectiveness of the treatment [33, 62]. In this study, a similar section titled “My Medications” was designated to help users manage and receive reminders about their drug intake. The interviewees acknowledged that, due to their work commitments and personal lives, they sometimes forget to take their medications. They considered this section, given its capabilities, a useful feature.
Research has revealed that interpersonal communication can serve as a source of comfort, and can influencing levels of stress and anxiety [63, 64]. However, none of the studies included in this review addressed this specific topic. In this research, we created a section titled “Chat Room,” which allows healthcare providers to discuss and exchange ideas. This section was designed in the application based on the opinions and suggestions of the interviewees.
M-Health tools, due to their constant availability, can effectively reduce anxiety when providing appropriate content. The study by Planas and Yuguero [28] supports this finding, indicating that health-oriented technologies have a significant potential to enhance mental health, particularly regarding depression and anxiety. In this context, previous studies [29, 30] have investigated the effectiveness of anxiety management applications for healthcare providers and have demonstrated that the use of these technologies is effective in alleviating anxiety. The findings obtained from the qualitative study indicated that the presence of a comprehensive application with useful sections could be effective given the users’ busy schedules. Since the application was the result of a systematic review and qualitative analysis, it can be concluded that the designed application serves as an effective mHealth tool.
Limitation of the study
The study did not conduct quantitative and qualitative analyses of the demographic information of the interviewees. Future research should explore the correlation between job position, gender, and anxiety levels in more detail. One of the limitations of this study is that we were unable to assess the effectiveness and efficiency of the application. Therefore, it is recommended that future research evaluates the impact of his approach. Another limitation is the limited number of studies on anxiety reduction identified during the literature review. As a result, we also included studies that focused on anxiety-related outcomes, such as stress. Another limitation of this study is that the developed application is in Persian, which restricts its use by non-Persian speakers and consequently limits the results and effectiveness of the application. It is recommended that future research develop an English version of this application.
Implications of study
In our systematic review, we identified studies that assessed the impact of mobile phone self-care applications on reducing anxiety among healthcare workers. Based on the findings of this review and the qualitative study, a comprehensive self-care application was developed. Researchers interested in investigating healthcare workers anxiety can use the framework established in this study. This application can be utilized by officials and policymakers in healthcare organizations across various health-related fields. The application provides healthcare providers with practical tools to manage anxiety, potentially improving their mental health and the quality of patient care. The use of ACT, mindfulness, and other strategies offers a holistic approach to anxiety management. This study highlights the need for continuous support and accessible tools for healthcare providers to manage work-related anxiety.
Future directions
The rapid growth and extensive application of technologies render their integration into the presented software highly valuable, as it can enhance the validation of anxiety levels, improve treatment quality, and offer superior services to users. The application and effectiveness of emerging technologies can enhance productivity, user experience, and engagement in future research software. The following summarizes several technologies and their applications within the designed software:
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Artificial Intelligence: This technology can function as a chatbot, allowing for the sharing of user anxiety test results with AI models specifically trained in this domain. Consequently, these intelligent chatbots can offer responses and guidance based on the analysis of test results and user interactions, accessible at any time and place, potentially aiding in the reduction of anxiety and depression.
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Wearable sensor networks comprise various cost-effective sensors that can record physiological data, including heart rate and sleep patterns, pertinent to anxiety and stress levels. The utilization of this network in isolation is insufficient, as it merely presents the gathered data within the software to enhance the user’s awareness of their current circumstances.
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Internet of Things: This technology enables the collection, storage, and transmission of diverse data, including information from connected wearable and biometric sensors. Such data can be analyzed in real time, allowing for the presentation of a health index and anxiety level to users online.
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Digital twin: A digital twin refers to a technology enhanced by AI and IoTs, characterized as a virtual representation of an individual or user. This technology enables the simulation of individual behavior using real-time IoTs data, which is analyzed through AI models. This process facilitates the monitoring and prediction of behavior, leading to the provision of precise treatment options.
The utilization of user data in the aforementioned ideas and solutions raises concerns regarding potential manipulation by profit-driven individuals, which may result in adverse outcomes, the adoption of inappropriate treatment methods, and erroneous drug prescriptions. Consequently, ensuring their security and privacy is key to building trust and enhancing service quality. The implementation of security technologies, including blockchain for its decentralized characteristics and post-quantum methods for their resilience against quantum attacks, can mitigate the risks associated with data sharing, usage, and manipulation, thereby addressing this issue effectively.
It is important to recognize that the capabilities of multiple technologies can be utilized simultaneously, rather than relying on a single one alone. An example of this situation involves the collection of user data through various means, including software test results, conversation history with both a doctor and a chatbot, medication records, and data obtained from wearable sensors. Subsequently, by employing machine learning algorithms derived from artificial intelligence, early detection of events such as panic attacks is achieved, with notifications sent to the physician via Internet of Things technology to facilitate the development of a treatment plan.